TY - JOUR

T1 - The underlying factors of excess mortality in 2020

T2 - a cross-country analysis of pre-pandemic healthcare conditions and strategies to cope with Covid-19

AU - Kapitsinis, Nikolaos

N1 - Funding Information: Healthcare systems that have historically been well funded and supported could assist in tackling a pandemic more efficiently []. There are four main healthcare models in terms of funding and access, as summarized by Wallace []. First, the Beveridge model that is government-financed through tax contributions providing for all citizens. Second, the Bismarck model is based on an insurance system, which is often co-financed by workers and employers, with healthcare providers frequently being private. Third, the National Health Insurance model comprises private hospitals and doctors, while being financed by a government insurance scheme funded by all taxpayers. Finally, the ‘out-of-pocket’ model, which is the most common, met in the medium and low-income countries, with healthcare services offered only to people affording to pay. Publisher Copyright: © 2021, The Author(s).

PY - 2021/12

Y1 - 2021/12

N2 - Background: Government responses to the pandemic varied in terms of timing, duration, and stringency, seeking to protect healthcare systems, whose pre-pandemic state varied significantly. Therefore, the severity of Covid-19 and, thus, excess mortality have been unequal across counties. This paper explores the geography of excess mortality and its underlying factors in 2020, highlighting the effects of health policies pre-pandemic and strategies devised by governments to cope with Covid-19. Methods: Excess mortality is estimated for 79 high, medium and low-income countries. The factors of excess mortality are examined employing median quantile regression analysis. Results: Health privatization, healthcare underfunding, and late implementation of containment and mitigation strategies were powerful drivers of excess mortality. By contrast, the results suggest a negative association of excess mortality with health expenditure, number of doctors and hospital beds, share of population covered by health insurance and test and trace capacity. Conclusions: The evidence highlights the importance of sufficiently funded healthcare systems with universal access and strong primary healthcare in the battle against the pandemic. An early response to Covid-19, including borders’ controls and a strong test and trace capacity, could improve epidemiological surveillance and minimize excess mortality, with stringent and lengthy lockdowns not providing a significant benefit.

AB - Background: Government responses to the pandemic varied in terms of timing, duration, and stringency, seeking to protect healthcare systems, whose pre-pandemic state varied significantly. Therefore, the severity of Covid-19 and, thus, excess mortality have been unequal across counties. This paper explores the geography of excess mortality and its underlying factors in 2020, highlighting the effects of health policies pre-pandemic and strategies devised by governments to cope with Covid-19. Methods: Excess mortality is estimated for 79 high, medium and low-income countries. The factors of excess mortality are examined employing median quantile regression analysis. Results: Health privatization, healthcare underfunding, and late implementation of containment and mitigation strategies were powerful drivers of excess mortality. By contrast, the results suggest a negative association of excess mortality with health expenditure, number of doctors and hospital beds, share of population covered by health insurance and test and trace capacity. Conclusions: The evidence highlights the importance of sufficiently funded healthcare systems with universal access and strong primary healthcare in the battle against the pandemic. An early response to Covid-19, including borders’ controls and a strong test and trace capacity, could improve epidemiological surveillance and minimize excess mortality, with stringent and lengthy lockdowns not providing a significant benefit.

KW - Covid-19

KW - Excess mortality

KW - Healthcare expenditure

KW - I11

KW - I18

KW - I3

KW - Lockdown

KW - Primary healthcare

KW - Test and trace

U2 - 10.1186/s12913-021-07169-7

DO - 10.1186/s12913-021-07169-7

M3 - Journal article

C2 - 34736434

AN - SCOPUS:85118723337

VL - 21

JO - BMC Health Services Research

JF - BMC Health Services Research

SN - 1472-6963

IS - 1

M1 - 1197

ER -